Complication Profiles of Corpectomy-Containing Versus Non-Corpectomy Anterior Cervical Surgery for Degenerative Cervical Myelopathy: A Multicenter Study of 1,024 Cases.

Abstract

Retrospective multicenter cohort study. To compare perioperative and late complication profiles between non-corpectomy and corpectomy-containing anterior cervical procedures for cervical myelopathy. Although anterior cervical surgery is effective for direct decompression of anterior cord compression, surgical invasiveness differs substantially according to whether corpectomy is required. Comprehensive perioperative and late complication profiles comparing non-corpectomy and corpectomy-containing procedures in large myelopathy cohorts remain insufficiently characterized. We reviewed 1,024 patients who underwent anterior cervical surgery for cervical myelopathy at three Japanese spine centers between 2011 and 2021. Patients were grouped into non-corpectomy procedures, including ACDF, TDR, or other disc-space-based procedures (n=617), and corpectomy-containing procedures, including ACCF or hybrid ACDF/ACCF procedures (n=407). Perioperative local complications, airway/swallowing-related complications, upper-extremity weakness, perioperative reoperation, late complications, and late reoperation were compared. Multivariable logistic regression evaluated associations between procedure group and complications. Compared with non-corpectomy procedures, corpectomy-containing procedures were associated with longer operative time, 308 versus 150 minutes, and greater blood loss, 307 versus 47 mL. Perioperative local complications occurred in 257 patients, 25.1%, and were more frequent after corpectomy-containing procedures than after non-corpectomy procedures, 38.1% versus 16.5%, P<0.001. Corpectomy-containing procedures also showed higher unadjusted rates of reoperation, 9.8% versus 2.4%; upper-extremity weakness, 13.0% versus 4.2%; dural injury, 17.4% versus 1.5%; upper airway obstruction, 8.8% versus 4.9%; and airway/swallowing-related complications, 20.9% versus 15.1%. After adjustment for age, sex, BMI, smoking, diabetes, and OPLL, corpectomy-containing procedures remained associated with perioperative local complications, odds ratio 1.82; 95% confidence interval, 1.22-2.72. However, this association was attenuated after additional adjustment for surgical extent. Corpectomy-containing procedures showed greater unadjusted perioperative morbidity than non-corpectomy procedures in patients undergoing anterior cervical surgery for myelopathy. Much of this increased complication burden appeared to reflect OPLL pathology and greater surgical extent. These findings may inform procedure selection, perioperative risk stratification, and patient counseling.